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Flashcards in HSM 546 KELLER Complete Class,HSM 546 KELLER Assignment,HSM 546 KELLER Course Deck (20):
1

HSM 546 Week 7 DQ 2 The Impact of Technology
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HSM 546 Week 7 DQ 2 The Impact of Technology
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What impact has technology had on the delivery of care under the managed healthcare model? What changes do you see in the future?

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2

HSM 546 Week 7 DQ 1 Issues Driving Federal Policy
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HSM 546 Week 7 DQ 1 Issues Driving Federal Policy
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What are the four central issues driving current federal health policy? Which do you believe is more important?



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3

HSM 546 Week 6 DQ 2 The Quality of Healthcare
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HSM 546 Week 6 DQ 2 The Quality of Healthcare
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The Institute of Medicine’s committee on the Quality of Health Care has six proposed areas for improvement in the healthcare system: safe, effective, patient centered, timely, efficient, and equitable. Select one of these areas and discuss why it was selected and identify its intended outcome.

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4

HSM 546 Week 6 DQ 1 The Regulatory Environment and Quality in Managed Care
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HSM 546 Week 6 DQ 1 The Regulatory Environment and Quality in Managed Care
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Discuss the link between legal issues, regulatory oversight, and quality improvement. Has regulatory oversight improved quality? If so, how? If not, why? Discuss types of MCO organizations.

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5

HSM 546 Week 6 Assignment Executive Summary Article Review
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HSM 546 Week 6 Assignment Executive Summary Article Review
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6

HSM 546 Week 5 Quiz
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HSM 546 Week 5 Quiz
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(TCO F) Which of the following payment policies addresses the issue of selection bias among Medicare risk plans?

(TCO F) Which of the following standardized measures for quality of care is commonly used for managed care and Medicare programs?

(TCO F) Which of the following represents the largest group of persons in the Medicaid program?

(TCO F) Outcomes of the TRICARE program suggest that _____.

(TCO F) Which of the following has been adopted as the new quality initiative within the military health system?

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7

HSM 546 Week 5 DQ 2 Social Insurance Medicare
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HSM 546 Week 5 DQ 2 Social Insurance Medicare
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The evolution of Medicare over the last 40 years has been significant. Discuss the current economic and access challenges that current enrollees of Medicare must navigate.

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8

HSM 546 Week 5 DQ 1 Social Insurance Medicaid
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HSM 546 Week 5 DQ 1 Social Insurance Medicaid
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Discuss the evolution of Medicaid from its inception to present. Discuss some of the reasons behind the decision of many states to use managed care models of delivery for the recipients of Medicaid.

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9

HSM 546 Week 4 DQ 2 Claims and Benefit Administration
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HSM 546 Week 4 DQ 2 Claims and Benefit Administration
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Explain the purpose of claims and benefits administration within a managed-care organization.

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10

HSM 546 Week 4 DQ 1 Consumer Strategy
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HSM 546 Week 4 DQ 1 Consumer Strategy
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Think about the numerous healthcare trends that are affecting employers. Which trends do you feel have the greatest impact on an employer and why? In your response, you may want to consider the size of the employer.

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11

HSM 546 Week 4 Assignment Managed Care Enrollment
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HSM 546 Week 4 Assignment Managed Care Enrollment
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12

HSM 546 Week 3 Quiz
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HSM 546 Week 3 Quiz
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(TCO D) Capitation will solve the issue(s) of _____.

(TCO D) Which of the following is the leading reason for member complaints?

(TCO D) Discuss how information technology (IT) can make disease-management programs more successful.

(TCO D) Which of the following is not necessarily a red flag for case management?

(TCO D) Which of the following aspects of the claims capability must be counted or measured in order to allocate adequate resources and verify financial assumptions about an insured population?

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13

HSM 546 Week 3 DQ 2 Managed Care Underwriting
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HSM 546 Week 3 DQ 2 Managed Care Underwriting
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Discuss problems that MCOs have experienced when implementing capitation arrangements in specialty-care practices.

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14

HSM 546 Week 2 DQ 2 The Effect of Human Behavior
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HSM 546 Week 2 DQ 2 The Effect of Human Behavior
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Explain what actions on the part of the HMO organization would likely cause negative physician behavior. Please provide an example to support your position.

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15

HSM 546 Week 2 DQ 1 Utilization Management
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HSM 546 Week 2 DQ 1 Utilization Management
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Discuss the concept of managing utilization. Incorporate into your discussion the role of the provider and case management. Describe the differences in managing the utilization for acute-care patients versus chronic-care patients.

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16

HSM 546 Week 2 Assignment You Decide Cooper Pearson Sports Marketing
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HSM 546 Week 2 Assignment You Decide Cooper Pearson Sports Marketing
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Scenario Summary:Cooper-Pearson Sports Marketing

Cooper-Pearsonis a very successful sports-marketing company with 75 employees. It has been in existence for 10 years, and it clearly has a bright future. One of the fundamental reasons for Cooper-Pearson’s phenomenal growth has been an investment in selecting the best and brightest men and women from colleges and universities throughout the United States and paying them well. Cooper-Pearson Sports Marketing has noticed that, in the past 2 years, 15 key senior employees have left the firm. Many of these men and women have joined Always on the Ball Sports Marketing Company, a competitor of Cooper-Pearson. During the exit interviews, one of the reasons that was consistently mentioned as a reason for leaving was the lack of adequate or affordable medical insurance.

Cooper-Pearson Sports Marketing managers have come to understand that a competitive compensation package must include medical benefits that employees want and can afford. They also understand that medical insurance has become an important recruitment tool in attracting quality employees. Like the company, quality coverage is extremely important, but so is cost.

Your Role

The company has engaged your services to research several insurance programs. First, compare and contrast the differences between an HMO, a PPO, and an indemnity insurance program. From the list below, select and discuss at least one other important service that Cooper-Pearson should consider when selecting an insurance program.

1. Discuss the importance of managed-care physician credentialing.

2. Explain the benefits of a prescription drug program to the employer and the employee.

3. Explain the importance of quality-management indicators in managed-care programs.

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17

HSM 546 Week 1 Quiz
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HSM 546 Week 1 Quiz
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(TCO B) The integral components of managed care are _____.

(TCO A) Which organization(s) need a corporate compliance officer (CCO)?

(TCO A) Basic elements of credentialing include _____.

(TCO B) When selecting a hospital during the network-development phase, an MCO considers the _____.

(TCO B) Common areas of clinical focus subject to hospital P4P programs include _____.

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18

HSM 546 Week 1 DQ 2 Managed Care Plans
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HSM 546 Week 1 DQ 2 Managed Care Plans
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What are PPO and POS plans? How do HMO plans differ from PPO plans?

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19

HSM 546 Week 1 DQ 1 HMO Formation
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HSM 546 Week 1 DQ 1 HMO Formation
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Why were HMOs formed? How has the relationship between the government and HMOs changed over the past 7 years?

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20

HSM 546 Entire Course
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HSM 546 Entire Course
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HSM 546 Week 1 DQ 1 HMO Formation

HSM 546 Week 1 DQ 2 Managed-Care Plans

HSM 546 Week 1 Quiz

HSM 546 Week 2 DQ 1 Utilization Management

HSM 546 Week 2 DQ 2 The Effect of Human Behavior

HSM 546 Week 2 HSM 546 You Decide Cooper-Pearson Sports Marketing

HSM 546 Week 3 DQ 1 Payment Mechanisms

HSM 546 Week 3 DQ 2 Managed-Care Underwriting

HSM 546 Week 3 Quiz

HSM 546 Week 4 DQ 1 Consumer Strategy

HSM 546 Week 4 DQ 2 Claims and Benefit Administration

HSM 546 Week 4 Managed Care Enrollment

HSM 546 Week 5 DQ 1 Social Insurance Medicaid

HSM 546 Week 5 DQ 2 Social Insurance Medicare

HSM 546 Week 5 Quiz

HSM 546 Week 6 DQ 1 The Regulatory Environment and Quality in Managed Care

HSM 546 Week 6 DQ 2 The Quality of Healthcare

HSM 546 Week 6 Executive Summary Article Review

HSM 546 Week 7 DQ 1 Issues Driving Federal Policy

HSM 546 Week 7 DQ 2 The Impact of Technology

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